Citation Nr: 21061858 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-46 600A DATE: October 5, 2021 ORDER Service connection for teeth extraction is denied. REMANDED Entitlement to an increased rating for migraines, currently rated as 30 percent disabling, is remanded. Entitlement to an increased rating for hypertension, currently rated noncompensable (0 percent), is remanded. Entitlement to a higher initial rating for a mood disorder, not otherwise specified, currently rated as 30 percent disabling, is remanded. Entitlement to a higher initial rating for degenerative changes of the right knee, currently rated as 10 percent disabling, is remanded. Entitlement to Dependents' Educational Assistance under 38 U.S.C. Chapter 35 is remanded. FINDING OF FACT The record does not reflect that the Veteran has a current dental disability for which compensation may be paid. CONCLUSION OF LAW The criteria for a grant of service connection for teeth extraction for compensation purposes have not been met. 38 U.S.C. §§ 1712, 5107; 38 C.F.R. §§ 3.381, 4.150, 17.161. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 2003 to June 2004, March 2008 to April 2009, and November 2009 to January 2011. This matter comes to the Board of Veterans' Appeals (Board) on appeal from rating decisions dated July 2012 and April 2015 by a Regional Office (RO) of the Department of Veterans Affairs (VA). Service connection for teeth extraction is denied. Service connection may be awarded for missing teeth due to dental trauma or bone loss in service. The law and regulations also provide that treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are considered non-disabling conditions and may be considered service-connected solely for the purpose of determining entitlement to VA dental examination or outpatient dental treatment. See 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161; see also Woodson v. Brown, 8 Vet. App. 352, 354 (1995). Service treatment records document in-service dental treatment. However, to establish entitlement to service connection for loss of a tooth, the Veteran must have sustained a combat wound or other in-service trauma. 38 U.S.C. § 1712; 38 C.F.R. § 3.381 (b). The Board notes that the term "service trauma" does not include the intended effects of therapy or restorative dental care and treatment provided during a Veteran's active service. See 38 C.F.R. § 3.306 (b)(1); VAOGCPREC 5-97. Further, the Federal Circuit defined "service trauma" as "an injury or wound produced by an external force during the service member's performance of military duties." Nielson v. Shinseki, 607 F.3d 802, 808 (Fed. Cir. 2010). The definition excluded "the intended result of proper medical treatment." Id. Here, no such trauma appears to be indicated by the service treatment records, nor does it appear that the Veteran explicitly identified such in her contentions. Even if the Veteran did have in-service dental trauma, only certain disabilities are subject to compensation under VA regulations. These disabilities include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Here, the Veteran has indicated that she had teeth extracted prior to going overseas. In a May 2013 correspondence, she stated that her gums were damaged as a result of the extractions, and that she lost bone in her upper mouth. The post-service medical records reflect treatment for dental problems, including an Oral Surgery Center proposal for Osseous surgery (bone graft). The Veteran underwent a VA examination in May 2017. The dentist concluded that the Veteran did not have a temporomandibular joint disability. Nor was he able to diagnose any dental disability upon which service connection could be granted. Consequently, there is no evidence which documents that the Veteran currently has a dental disability for which compensation may be paid under 38 C.F.R. § 4.150. In view of the foregoing, the Board concludes the preponderance of the evidence is against the Veteran's claim of entitlement to a dental disorder for compensation purposes, and it must be denied. REASONS FOR REMAND Entitlement to an increased rating for migraines, hypertension, a mood disorder, and degenerative changes of the right knee, is remanded. The most recent VA examination of the Veteran's hypertension and migraines is dated March 2015. The most recent VA psychiatric examination is also dated March 2015. The most recent VA examination of the Veteran's right knee is dated May 2015. Although a new examination is not required simply because of the time which has passed since the last examination, VA's General Counsel has indicated that a new examination is appropriate when there is an assertion of an increase in severity since the last examination. VAOPGCPREC 11-95 (1995). In this case, the Veteran submitted a private opinion dated September 2016 that purportedly reflects an increase in severity of the migraine headaches and right knee disability. Treatment reports reflect continued psychiatric treatment and treatment for hypertension. A remand is warranted so that the Veteran can undergo VA examinations that will reveal the current severity of her disabilities. Entitlement to Dependents' Educational Assistance under 38 U.S.C. Chapter 35 is remanded. The Veteran's claim for Dependents' Educational Assistance under 38 U.S.C. Chapter 35 is dependent on whether the Veteran has a has a permanent and total service-connected disability. As such, the claim is inextricably intertwined with the issue of whether increased ratings are warranted for migraines, hypertension, a right knee disability, and mood disorder. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected mood disorder. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms and social and occupational impairment due to her service-connected mood disorder alone. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected right knee disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups or with repeated use over time. The functional loss should be expressed in terms of range of motion. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected migraines. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected hypertension. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Prem, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.